“July Effect” Doesn’t Apply to Length of Surgery

ATLANTA – Jan. 23, 2015 – The “July Effect” – when newly trained physicians begin their residency at teaching hospitals, potentially increasing the risk of medical errors – doesn’t appear to lengthen surgeries during that month, according to a study presented at the American Society of Anesthesiologists® PRACTICE MANAGEMENT 2015 meeting. That study and other research presented at the meeting reflects the significant and ongoing efforts physician anesthesiologists make to improve patient care:

“July Effect” doesn’t affect surgery times: Because new (inexperienced) resident medical doctors typically begin in the summer, there is heightened concern about the July Effect, meaning a spike in medical errors. Researchers at Stanford University and the University of Vermont wondered if this resulted in longer surgery times because teaching a new physician takes extra time compared to an experienced physician anesthesiologist or surgeon performing those tasks. Researchers analyzed surgical times month to month at a large teaching hospital over a period of nearly five years. They found no significant differences, either in the average total monthly operating minutes, or in the average daily operating minutes for July compared to the other months, said study author Joseph A. Sanford, Jr., M.D., a fellow in the management of perioperative services at Stanford University, Stanford, Calif. He noted that there likely was no appreciable difference because hospitals put controls in place to limit the affect new residents may have on surgeries, including easing them slowly into the training environment and other policies.

New preop clinic benefits patients: By completely changing the workflow for handling outpatient procedures involving anesthesia, San Francisco General Hospital (SFGH) was able to improve efficiency and increase satisfaction among patients and physicians. Under the previous system, patients saw the physician anesthesiologist right before surgery, which led to a number of cancelled procedures because of concerns that health and other safety issues hadn’t been resolved, said lead author Oliver C. Radke, M.D., Ph.D., medical director of the Anesthesia Preop Clinic at SFGH . Under the new system, the surgery clinics still see patients and decide on surgical interventions, but more than 80 percent of patients are then referred to the preoperative clinic, where the patient’s medication is assessed, a full physical is performed and the physician anesthesiologist discusses the anesthesia, orders tests and resolves issues if necessary as well as answering any questions the patient may have. As a result, cancellation rates for medical reasons are nearly zero, preoperative testing has been significantly reduced, and because the history and physical is conducted during the preop clinic visit, the patient doesn’t have to make an extra visit to the surgical clinics for the mandatory 30-day history and physical. Patients report high satisfaction with the new system, and physician anesthesiologists say patients are much better evaluated and prepared than previously. All of the anesthesia providers at SFGH agree that the anesthesia preop clinic saves time in the operating room. Additionally, the preop clinic turned out to be the ideal place to initiate the implementation of clinical pathways.

“Gaming” motivates surgeons to improve scheduling: Evidently just about everyone is motivated by a reward, including surgeons. Stanford University researchers implemented gaming mechanics, motivating surgeons to more accurately estimate the time it would take to complete a surgery and therefore help hospitals plan operating room time efficiently. Prior to the study, there was a 58.5 percent scheduling error among 32 surgeries, meaning the surgeries went 58.5 percent longer on average than surgeons had anticipated. After the gaming intervention, the surgeries went only 20 percent longer on average (based on nine surgeries), a 38 percent improvement. Surgeons who improved their surgery estimations were rewarded with increased operating room block time and additionally were less likely to have their surgeries cancelled due to insufficient staffing, said lead author Brandi Sinkfield, M.D., digital health fellow in the Anesthesia Informatics and Media Lab at Stanford University, Stanford, Calif. The gaming mechanism of increased block time motivated surgeons to more accurately estimate the time a surgery would take. “Consequently, this helps the operating room managers plan for sufficient staffing and ultimately leads to better performance,” she said.

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PRACTICE MANAGEMENT 2015Premier Educational Event for Physician Anesthesiologists and Practice Administrators – the PRACTICE MANAGEMENT 2015 conference – will take place January 23-25 at the Atlanta Marriott Marquis in Atlanta. The meeting helps physician anesthesiologists stay up-to-date on the latest legislative and regulatory changes, new payment models and technology advancements affecting today’s anesthesiology practice. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag # ASAPM15.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS®Founded in 1905, the American Society of Anesthesiologists (ASA®) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.

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